Case Of Tension Pneumocephalus Research Articles

Tension Pneumocephalus in a Posttraumatic Patient: Computed Tomographic Findings and Case Report

Tension pneumocephalus is an unusual bad life-threatening neurosurgical emergency, this is the equivalent of tension pneumothorax. This often follows head trauma, epidural injections, complicating neurological spinal, craniofacial or sinus surgery. This is a forty-five-year-old man that was involved in a road traffic accident, was referred for a computed tomography of the brain on account of altered consciousness, irrational behavior, and restlessness. A non-contrast enhanced computed tomography of the brain was done, this demonstrated multiple areas of cortical discontinuity in the facial and skull vaults in keeping with fractures, extensive negative density (HU: -968) hypodensity in the frontal region bilaterally causing marked inferior displacement of both frontal lobes of the brain, with associated splaying of the interhemispheric fissure likened to the ‘Mount Fuji sign’ of severe/tension pneumocephalus. Pockets of negative density hypodensities are also noted in both cerebral hemispheres in keeping with pneumatoceles are also demonstrated. Generalized effacement of sulci and gyri in keeping with cerebral edema is also demonstrated. The outcome of the patient in the peripheral center was not known as at the time of this report, because all effort to get across to the patient and relations proved abortive. We present a case of tension pneumocephalus following road transport accident, to review the computed tomographic features due to its peculiar presentation.

Delayed Tension Pneumocephalus Following Frontal Sinus Fracture.

Case PresentationWe describe a delayed case of tension pneumocephalus in a newly altered patient 21 days status-post auto-vs-pedestrian accident. After her initial hospital course, the patient was discharged to an acute rehabilitation facility in stable condition with Glasgow Coma Scale 15. The patient returned to the emergency department for an acute change in mental status.DiscussionTension pneumocephalus is a neurosurgical and otolaryngological emergency.

Trauma-Associated Tension Pneumocephalus with Characteristic Mount Fuji Sign—Case Report

AbstractTension pneumocephalus is a rare and life-threatening neurosurgical emergency in the setting of blunt or penetrating head trauma, especially in those with craniofacial fractures, which emergency physicians should be aware about. Early identification and appropriate treatment measures including supine positioning, 100% oxygen via mask, early neurosurgery consultation and, if required, operative intervention are paramount to optimal neurological and survival outcome. Definitive diagnosis requires imaging usually in the form of computed tomography (CT) head and serial monitoring of neurological status, optic nerve sheath diameter measurement and repeat imaging, essential to identify patients who might have features of increased pressure on brain matter, which could lead to adverse neurological and clinical outcomes. We present two cases of tension pneumocephalus with the characteristic Mount Fuji sign on CT head, who were managed nonoperatively with optimal neurological outcome. In patients with severe head or maxillofacial trauma presenting to emergency department, CT should be evaluated for signs of tension pneumocephalus, and such patients need to be closely observed for complications of pressure effect on brain matter to ensure optimal neurological and survival outcomes.

Tension Pneumocephalus: A Rare Complication Following Skull Base Surgery

Tension pneumocephalus (TP) is a rare complication following skull base surgery with potentially deadly consequences if not recognized and treated quickly. Characterized by the presence of air with a pressure gradient inside of the intracranial vault capable of causing mass effect, TP can result in altered mental status, seizures, or even death. We present the case of a 52-year-old male with recurrent hemangiopericytoma who underwent tumor resection and reconstruction complicated by tension pneumocephalus. It was determined to be caused by a failure of the drain site closure in the setting of a lumbar drain, thus resulting in an “inverted soda bottle” effect leading to TP. We review the reported cases of TP in skull base surgery and highlight the importance of ensuring drain site closure in order to prevent the development of tension pneumocephalus after skull base surgery.

Tension Pneumocephalus from Endoscopic Endonasal Surgery: A Case Series and Literature Review

Background: Tension pneumocephalus (TP) caused by endoscopic endonasal surgery is a serious complication. We report 4 cases of TP caused by endoscopic surgery and review other cases in the literature, with special attention given to the symptoms, imaging manifestations, therapeutic approaches. Methods: We performed a retrospective chart review of patients with TP caused by endoscopic surgery in our institution from 2015 to 2018. Additionally, the MEDLINE database was searched for all case series or reports of TP caused by endoscopic surgery. Findings: Seventeen articles were identified for review, including the 4 cases from the authors' institution. Ultimately, a total of 25 cases were included in this study. The main symptoms of TP were headache and change in mental status. Cerebrospinal fluid (CSF) leakage was reported in 21 patients (21/25, 84.0%). Eight patients (8/25, 32.0%) presented with the Mount Fuji sign imaging characteristic. Twenty-three patients were treated with surgical intervention for TP (endoscopic multilayer closure of skull base defect, cranial burr hole, bifrontal craniotomy). In addition, we first reported that 2 patients with TP were successfully given conservative treatment. Interpretation: The therapeutic method of TP should depend on the degree of the mass effect and clinical symptoms. When patients with TP presented with obvious symptoms of CSF leakage and intracranial hypertension, urgent surgical multilayer repair of the skull base defects or/and release of the intracranial pressure were the keys to treating these patients. However, conservative treatment under close observation was also feasible when the related symptoms were not obvious. Funding Statement: This work was financially supported by the National Natural Science Foundation of China (No. 81870703). Declaration of Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Ethical Approval Statement: This study was approved by the Institutional Review Board of AEENTH at Fudan University.

A case of tension pneumocephalus with Mount Fuji sign

Abstract not availableBangladesh Crit Care J March 2018; 6(1): 57-59

Traumatic tension pneumocephalus - Two cases and comprehensive review of literature.

Although traumatic pneumocephalus is not uncommon, it rarely evolves into tension pneumocephalus (TP). Characterized by the presence of increasing amounts of intracranial air and concurrent appearance or worsening neurological symptoms, TP can be devastating if not recognized and treated promptly. We present two cases of traumatic TP and a concise review of literature on this topic. Two cases of traumatic TP are presented. In addition, a literature search revealed 20 additional cases, of which 18 had sufficient information for inclusion. Literature cases were combined with the 2 reported cases and analyzed for demographics, mechanism of injury, symptoms, time to presentation (acute <72 h; delayed >72 h), diagnostic/treatment modalities, and outcomes. Twenty cases were analyzed (17 males, 3 females, median age 26, range 8–92 years). Presentation was acute in 13/20 and delayed in 7/20 patients. Injury mechanisms included motor vehicle collisions (6/20), assault/blunt trauma to the craniofacial area (5), falls (4), and motorcycle/ bicycle crashes (3). Common presentations included depressed mental status (10/20), cerebrospinal fluid rhinorrhea (9), headache (8), and loss of consciousness (6). Computed tomography (CT) was utilized in 19/20 patients. Common underlying injuries were frontal bone/sinus fracture (9/20) and ethmoid fracture (5). Intracranial hemorrhage was seen in 5/20 patients and brain contusions in 4/20 patients. Nonoperative management was utilized in 6/20 patients. Procedural approaches included craniotomy (11/20), emergency burr hole (4), endoscopy (2), and ventriculostomy (2). Most patients responded to initial treatment (19/20). One early and one delayed death were reported. Traumatic TP is rare, tends to be associated with severe craniofacial injuries, and can occur following both blunt and penetrating injury. Early recognition and high index of clinical suspicion are important. Appropriate treatment results in improvement in vast majority of cases. CT scan is the diagnostic modality of choice for TP.Republished with permission from:Pillai P, Sharma R, MacKenzie L, Reilly EF, Beery II PR, Papadimos TJ, Stawicki SPA. Traumatic tension pneumocephalus: Two cases and comprehensive review of literature. OPUS 12 Scientist 2010;4(1):6-11.

Traumatic Tension Pneumocephalus After Blunt Head Trauma and Positive Pressure Ventilation

Pneumocephalus following head trauma is relatively rare, with tension pneumocephalus occurring in an even smaller group of patients. This review presents a recent case of tension pneumocephalus following the use of a manually operated bag–valve–mask to assist ventilations prior to rapid-sequence intubation. A discussion of this case in terms of other reported cases of pneumocephalus after oxygen therapy follows. A limited number of current case reports identified in the literature indicate a connection between pneumocephalus and positive pressure ventilation following blunt trauma. Continuous positive airway pressure (CPAP) ventilation use in patients with an undiagnosed skull fracture is the most common reported cause of ventilation-related pneumocephalus. The case review presented here identifies the use of a bag–valve–mask prior to intubation as a possible contributory cause of the tension pneumocephalus. With only one prior case reported in the literature of pneumocephalus following the use of a bag–valve–mask, this case is unique and may indicate the need for additional awareness for this rare complication. The prehospital diagnosis of pneumocephalus is difficult, as the symptoms and mechanism of injury mimic those associated with intracranial hemorrhage. The use of mannitol in the prehospital treatment of this patient and subsequent improvement in pupillary response may indicate that mannitol has a role in the treatment of tension pneumocephalus when neurosurgical services are not readily available. Additional research is needed to better understand the benefits and risks associated with this treatment modality.

Tension pneumocephalus as complication of burr-hole drainage of chronic subdural hematoma: A case report

Background:Pneumocephalus is the presence of air in the cranial cavity. When this intracranial air causes increased intracranial pressure and leads to neurological deterioration, it is known as tension pneumocephalus (TP). TP can be a major life-threatening postoperative complication, especially after evacuation of chronic subdural hematoma. We report a case of TP after evacuation of chronic subdural hematoma and review the literature.Case Description:A 70-year-old man developed right-sided weakness after being admitted with minor head trauma a few weeks earlier. He was found to have a chronic subdural hematoma and underwent burr-hole evacuation. On day 3, he suddenly deteriorated and needed intubation and ventilation. Computerized tomography (CT) of the brain showed typical Mount Fuji’s sign due to TP. Immediately, 20-30 mL of air was aspirated from the intracranial fossa, and a catheter drain was inserted. The patient became fully awake after few hours and was extubated successfully. The drain was removed on day 5, and he was transferred to the ward before being discharged home.Conclusion:TP after evacuation of a chronic subdural hematoma is a neurosurgical emergency and needs immediate resuscitation and therapy; hence it is of vital importance that all acute-care physicians, intensivists and neurosurgeons be aware of this clinical emergency.

Brain stem tension pneumocephalus leading to respiratory distress after subdural haematoma evacuation

Brain stem tension pneumocephalus leading to respiratory distress after subdural haematoma evacuation

Tension pneumocephalus complicating Pancoast tumor resection

A case of tension pneumocephalus following Pancoast tumor resection is presented. Conservative management was successful. The presenting symptoms and signs, diagnostic methods and options for treatment are discussed and reviewed.

Changing patterns of tracheotomy use in anterior skull base surgery with free tissue reconstruction

To evaluate how changing patterns of tracheotomy use with free tissue reconstruction of the anterior skull base affect postoperative complications. Retrospective comparison of clinical cohort to historic control group. Tertiary care medical center. We reviewed 201 patients with a diagnosis of malignant or locally aggressive benign neoplasms of the nasal cavity and paranasal sinuses between January 1993 and December 2006. Of these, we studied 33 consecutive patients that underwent ablative anterior skull base surgery reconstructed with free tissue transfers. We divided the study group into two cohorts: Group 1, patients treated from 1993-2000, and Group 2, patients treated from 2000-2006. Tracheotomy use and postoperative complications. There were 16 patients in Group 1 and 17 patients in Group 2. There were 11 patients who received a tracheotomy in Group 1, and only 5 in Group 2 (P = .038). Five patients in either group experienced complications (P = 1.000). There was one case of meningitis in Group 1 and no cases in Group 2 (P = .485). There were two cases of pneumocephalus in Group 2 and none in Group 1 (P = .485) and no cases of tension pneumocephalus. Six patients in each group had recurrent disease (P = 1.000). There was no statistically significant difference in survival (P = .675). The decreased use of tracheotomy in patients undergoing free tissue transfer reconstruction of anterior skull base defects did not lead to an increase in complications. Routine use of tracheotomy in these patients is unnecessary and should be reserved for selected cases. Laryngoscope, 2009.

The Use of Nasopharyngeal Airways for Airway Diversion in Anterior Craniofacial Resection

Tension pneumocephalus is an uncommon, but life-threatening, postoperative complication associated with craniofacial resection. This study was performed to evaluate our institution's experience using nasal trumpets for airway diversion. A retrospective chart review was performed of patients who underwent anterior craniofacial resection (ACR) from 2000 to 2006. After Institutional Review Board approval, charts were reviewed with specific attention to short- and long-term complications. Twenty-two patients have undergone ACR since 2000 and had nasopharyngeal airways postoperatively. Nineteen patients (86.4%) were extubated on the day of surgery. Fourteen patients (63.6%) spent 1 day in an intensive care unit for observation. Nasal trumpets remained in place for an average of 7.3 days and patients had an average hospital stay of 7.4 days. Complications occurred in 14 patients (63.6%), with infection as the most common cause. No cases of tension pneumocephalus, meningitis, epidural abscess, or bone flap loss occurred in this group of patients. We present the use of nasopharyngeal airways in postoperative ACR patients as a successful method of airway diversion, which can significantly reduce the incidence of postoperative pneumocephalus and related morbidity.

A Rational Approach to the Use of Tracheotomy in Surgery of the Anterior Skull Base

To offer an algorithm for airway management in anterior skull base surgery. This is a retrospective review of 109 patients undergoing major anterior skull base surgery from a single senior surgeon's experience from September 1997 to May 2006. We report only one (1%) postoperative mortality in this series and only seven major complications in six patients, including two cases of stroke, one case of cerebrospinal fluid (CSF) leak, and four cases of delayed osteoradionecrosis. No patients in this series developed tension pneumocephalus. The total major complication rate is 6%. Fifty-one (47%) patients received prophylactic tracheotomy, and 58 (53%) patients did not receive prophylactic tracheotomy. Eighty-eight (81%) patients received anterior skull base reconstruction with local flaps. Six (5.5%) patients required primary reconstruction with a free flap. We attribute the very low rate of major complications in this series and, in particular, no cases of tension pneumocephalus and rarity of CSF leaks primarily to prophylactic tracheotomy in selected patients and to a reconstructive strategy that emphasizes use of local vascularized tissue to reconstruct the anterior skull base.

Tension pneumocephalus – a rare complication of radiotherapy: A case report

We present a rare case of tension pneumocephalus due to high-dose radiotherapy used to treat nasopharyngeal carcinoma. A skull base defect causing tension pneumocephalus was identified and was repaired successfully. The case emphasizes the importance of careful consideration before applying irradiation treatment to patients with head and neck malignancy and urges early detection of potentially life-threatening complications.

Tension pneumocephalus and pneumorachis secondary to subarachnoid pleural fistula.

A case of tension pneumocephalus and pneumorachis secondary to a subarachnoid pleural fistula after thoracic spinal surgery is described. This rare complication was diagnosed on CT. The imaging findings, significance and management of this unusual condition are discussed.

Tension Pneumocephalus: Acute Neurological Deterioration Associated with Pleocytosis of the CSF

Tension pneumocephalus is an uncommon condition characterized by dramatic neurological deterioration and massive accumulations of intracranial air. Inflammatory changes in the CSF may mimic an infectious process. In this report we describe a case of tension pneumocephalus in which the patient presented with pleocytosis of the CSF.

Tension Pneumocephalus following Ventriculo-peritoneal Shunt

A case of tension pneumocephalus following ventriculo-peritoneal shunt is reported. A 28-year-old male was admitted with the diagnosis of arteriovenous malformation at the right temporooccipital lobe. Uneventful total removal of the arteriovenous malformation was performed. However, postoperatively symptoms of arterial vasospasm and progressive hydrocephalus developed, so a ventriculo-peritoneal shunt was inserted. The postoperative course was good, but about 3 weeks after the operation, the clinical symptoms aggravated gradually and computerized tomography scan showed expanding intraventricular air. At the reoperation, a small skin defect covered by crust was found at the shunt surgery wound, and the dura mater around the shunting tube remained as a defective space. It was suspected that the air invaded the lateral ventricles along the shunting tube through the skin and dura defect. Twelve similar cases could be found in the literature.

仰が位開頭手術後に発生した緊張性気脳症

Tension pneumocephalus is a serious and life-threatening complication after craniotomy, and many cases have been reported after craniotomy in the sitting position. The definitive treatment is the surgical aspiration of air via burr holes. We report two cases of tension pneumocephalus after craniotomy in the supine position, whose neurological status improved prior to the surgical intervention.One patient with metastatic brain tumor in the left frontoparietal lobe was operated on for the removal of the tumor in the supine position under neuroleptanesthesia. After the operation, the patient showed a delayed recovery, and an emergency CT scan revealed a large amount of bilateral subdural air. The other with infiltrating pituitary tumor was undewent the right frontotemporal craniotomy for the removal of the tumor under nitrous oxide and enflurane anesthesia. After full awakening from anesthesia, gradual deterioration in the neurological status needed an emergency CT scan, which showed air in the right frontotemporal epidural space with the midline shift to the left. The neurological status of the two patients improved fortunately prior to the surgical intervention, while receiving intravenous mannitol and steroids with continuous inhalation of oxygen. The postoperative repeated CT scans taken after one week showed only minimal cerebral edema without definite accumulation of air in both cases.